Brewing epidemic of communicable diseases after massive flooding in Pakistan
Authors: Hassan Mumtaz, Maham Zahid, Rehama Iqbal
Journal: International Journal of Surgery (2023)

It is well known that natural disasters disrupt ecosystems, posing numerous dangers to the habitat including humans and animals. There are two main causes, one is the nature itself while the other is anthropogenic alterations to the climate. The phenomenon of global warming due to human activities such as deforestation, unplanned urbanization, and irresponsible use of fossil fuel, is making extreme weather-related natural disasters more common. Low- and middle-income nations are particularly vulnerable to the health-related aftereffects of natural disasters1. Floods are one of the most common and severe geoenvironmental disaster caused by extreme rains, high water levels in rivers and around coastlines. Thus, leading to substantial losses of infrastructure, economic output, social capital, health, and human life2. An outbreak of communicable infectious illnesses among the affected community is the most dreaded outcome of flooding. Pakistan is the fifth most vulnerable country in the world due to climate change. In Pakistan, causes of both upstream and downstream river floods are multiple including unpredicted irregular heavy rainfall, unexpected glacier melting in peak summers, and variable monsoon rain spells3. Massive floods have historically hit Pakistan every year during the monsoon months of June–August. History is coming back even harder today in 2022 after being witnessed to devasting flood catastrophes in the year 2010, 2011, 2012, and 2014, all of which were caused by unpredicted excessive monsoon rainfall overpowering the mighty majestic Indus River. Over 2.4 million people were affected by the heavy rain floods in 2010, and, the economy lost a total of $10 billion. The floods destroyed homes, roads, bridges, crops, and livestock, and were responsible for at least 2000 human deaths, 3000 human injuries, and an untold number of animal deaths4. This year, six strong monsoon events were recorded, beginning in early June 2022, and continuing throughout August; these episodes affected 116 districts, with 66 of those districts being deemed calamity-hit. There has been 375.4 mm of rain since 25 August 2022, which is 2.87 times as much as the national 30-year average of 130.8 mm. The National Disaster Management Authority declared a national emergency as 3.3 million people have been impacted and 937 individuals have lost their lives. The provinces of Sindh and Baluchistan were the worst hit, with increases in precipitation of 784 and 500%, respectively. In the Baluchistan region, 0.67 million homes were destroyed, 17560 schools were damaged, 3082 km of roads were damaged, 145 bridges were destroyed, and 0.7 million livestock animals were killed5. Since mid-June, the monsoon rains have claimed the lives of at least 1033, as reported in the media, with 119 of those lives lost just in the past day. It was projected that 2000 homes were lost in the floods. Sindh braced for new deluge from swelling rivers in the north6. Approximately 30 million people in Pakistan have been impacted by the flooding that has killed more than 1000 people. According to Reuters Asia Pacific news, the Kabul River rose due to flash floods in Khyber Pakhtunkhwa Province. A bridge was washed away by the swiftly rising river, effectively blocking off access to certain neighborhoods, as shown in Figure 1. Around 180 thousand residents of the Charsadda district were compelled to abandon their homes. Some others even slept on the roads with their animals7.Figure 1: Infrastructure destroyed by the massive flooding.Internal displacement is happening all over the country, despite massive rescue operation. The people of Pakistan, governmental and nongovernmental humanitarian organizations are striving hard to generate resources while prioritize existing ones to meet the most critical needs while also seeking to scale up the emergency response in the most severely impacted areas. It is important to note that in 2010 floods, there were about 6.2 million cases of serious diarrhea, respiratory infections, skin illnesses, measles, polio, Crimean-Congo hemorrhagic fever, dengue fever, and malaria reported. The second most common health issue after floods is gastrointestinal tract infections due to the absence of sanitation, clean showers, and safe drinking water in the rescue camps8. Many cases of dengue were reported in Karachi during the floods of 2010–2014, leading to a total of 704 188 fatalities. Studies have shown that floods were substantially linked to an elevated incidence of dysentery, acute hemorrhagic, conjunctivitis, influenza, and tuberculosis9. We would like to emphasize that Pakistan is in for a long haul as flooding is followed by outbreaks of communicable infectious diseases. In the current context, it is very much likely that in coming time there can be numerous outbreaks of respiratory infections, gastrointestinal infections, malaria, dengue, measles, and polio. Therefore, it is imperative that provincial and federal health departments should set up early disease outbreak detection, response, and surveillance mechanism in all the affected districts, activates incident management system with designated teams functioning out of emergency operating centers, deploys field teams, activates stockpiles of essential supplies, including medicines, vaccines, and personal protective equipment, establishes networks and base camps where needed and communicates the risk to the community. Addressing this public health emergency through quick and effective action is the only way to save many lives. Ethical approval Not applicable. Sources of funding None. Authors’ contribution M.Z.: concept. R.I.: manuscript writing. H.M.: editing and review. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Hassan Mumtaz. Provenance and peer review Not commissioned, externally peer-reviewed.